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Cost-effectiveness of internet-based training for primary care clinicians on antibiotic prescribing for acute respiratory tract infections in Europe

Cost-effectiveness of internet-based training for primary care clinicians on antibiotic prescribing for acute respiratory tract infections in Europe
Cost-effectiveness of internet-based training for primary care clinicians on antibiotic prescribing for acute respiratory tract infections in Europe
Objectives: Overprescribing of antibiotics by general practitioners (GPs) is seen as a major driver of antibiotic resistance. Training in communication skills and C-reactive protein (CRP) testing both appear effective in reducing such prescribing. This study assesses the cost-effectiveness (compared with usual care) of: (i) training GPs in the use of CRP testing; (ii) training GPs in communication skills; and (iii) training GPs in both CRP testing and communication skills.Methods: Economic analyses [cost-utility analysis (CUA) accounting for the cost of antibiotic resistance and cost-effectiveness analysis (CEA)] were both conducted from a healthcare perspective with a time horizon of 28 days alongside a multinational, cluster, randomized, factorial controlled trial in patients with respiratory tract infections in five European countries. The primary outcome measures were QALYs and percentage reduction in antibiotic prescribing. Hierarchical modelling was used to estimate an incremental cost per QALY gained and an incremental cost per percentage reduction in antibiotic prescribing.Results: Overall, the results of both the CUA and CEA showed that training in communication skills is the most cost-effective option. However, excluding the cost of antibiotic resistance in the CUA resulted in usual care being the most cost-effective option. Country-specific results from the CUA showed that training in communication skills was cost-effective in Belgium, UK and Netherlands whilst training in CRP was cost-effective in Poland.Conclusions: Internet-based training in communication skills is a cost-effective intervention to reduce antibiotic prescribing for respiratory tract infections in primary care if the cost of antibiotic resistance is accounted for.
0305-7453
3189-3198
Oppong, Raymond
fe6a54b3-9bdb-4117-9697-a19935d92a2d
Smith, Richard D.
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Little, Paul
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Verheij, Theo
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Butler, Christopher C.
c8cc70b1-5fb9-4b03-bb80-11c6aabb7e6f
Goossens, Herman
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Coenen, Samuel
3d0dc4e0-e5ba-4d66-ba92-15900ccc551e
Coenen, Samuel
3d0dc4e0-e5ba-4d66-ba92-15900ccc551e
Jowett, Sue
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Roberts, Tracy E.
6964df84-5fec-42a5-aa2f-fb207b6fb2dc
Achana, Felix
d72dd14c-1a24-4697-b2cf-9c19558d993b
Stuart, Beth
a51c80d3-5855-4672-b24f-8c65fd2e1444
Coast, Joanna
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Oppong, Raymond
fe6a54b3-9bdb-4117-9697-a19935d92a2d
Smith, Richard D.
3d8223af-9e0a-43c6-ba61-1a693a5f4014
Little, Paul
1bf2d1f7-200c-47a5-ab16-fe5a8756a777
Verheij, Theo
772e019f-486f-4a64-9260-bac6446a85d2
Butler, Christopher C.
c8cc70b1-5fb9-4b03-bb80-11c6aabb7e6f
Goossens, Herman
31f8e1ae-7da0-473c-bd49-f911c2187451
Coenen, Samuel
3d0dc4e0-e5ba-4d66-ba92-15900ccc551e
Coenen, Samuel
3d0dc4e0-e5ba-4d66-ba92-15900ccc551e
Jowett, Sue
97638e31-26f6-4d01-8a58-8bca0eb80053
Roberts, Tracy E.
6964df84-5fec-42a5-aa2f-fb207b6fb2dc
Achana, Felix
d72dd14c-1a24-4697-b2cf-9c19558d993b
Stuart, Beth
a51c80d3-5855-4672-b24f-8c65fd2e1444
Coast, Joanna
062a356d-95a4-46f0-af55-6f1438e8cd4d

Oppong, Raymond, Smith, Richard D., Little, Paul, Verheij, Theo, Butler, Christopher C., Goossens, Herman, Coenen, Samuel, Coenen, Samuel, Jowett, Sue, Roberts, Tracy E., Achana, Felix, Stuart, Beth and Coast, Joanna (2018) Cost-effectiveness of internet-based training for primary care clinicians on antibiotic prescribing for acute respiratory tract infections in Europe. Journal of Antimicrobial Chemotherapy, 73 (11), 3189-3198. (doi:10.1093/jac/dky309).

Record type: Article

Abstract

Objectives: Overprescribing of antibiotics by general practitioners (GPs) is seen as a major driver of antibiotic resistance. Training in communication skills and C-reactive protein (CRP) testing both appear effective in reducing such prescribing. This study assesses the cost-effectiveness (compared with usual care) of: (i) training GPs in the use of CRP testing; (ii) training GPs in communication skills; and (iii) training GPs in both CRP testing and communication skills.Methods: Economic analyses [cost-utility analysis (CUA) accounting for the cost of antibiotic resistance and cost-effectiveness analysis (CEA)] were both conducted from a healthcare perspective with a time horizon of 28 days alongside a multinational, cluster, randomized, factorial controlled trial in patients with respiratory tract infections in five European countries. The primary outcome measures were QALYs and percentage reduction in antibiotic prescribing. Hierarchical modelling was used to estimate an incremental cost per QALY gained and an incremental cost per percentage reduction in antibiotic prescribing.Results: Overall, the results of both the CUA and CEA showed that training in communication skills is the most cost-effective option. However, excluding the cost of antibiotic resistance in the CUA resulted in usual care being the most cost-effective option. Country-specific results from the CUA showed that training in communication skills was cost-effective in Belgium, UK and Netherlands whilst training in CRP was cost-effective in Poland.Conclusions: Internet-based training in communication skills is a cost-effective intervention to reduce antibiotic prescribing for respiratory tract infections in primary care if the cost of antibiotic resistance is accounted for.

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Accepted version of paper JAC Nov 2018 - Accepted Manuscript
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Accepted/In Press date: 9 July 2018
e-pub ahead of print date: 27 August 2018
Published date: 1 November 2018

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Local EPrints ID: 425941
URI: http://eprints.soton.ac.uk/id/eprint/425941
ISSN: 0305-7453
PURE UUID: 42666c85-f3d9-464b-a3b7-6e6d8518a215

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Date deposited: 07 Nov 2018 17:30
Last modified: 07 Oct 2020 04:48

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Contributors

Author: Raymond Oppong
Author: Richard D. Smith
Author: Paul Little
Author: Theo Verheij
Author: Christopher C. Butler
Author: Herman Goossens
Author: Samuel Coenen
Author: Samuel Coenen
Author: Sue Jowett
Author: Tracy E. Roberts
Author: Felix Achana
Author: Beth Stuart
Author: Joanna Coast

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